Loopholes exploited after aged care reforms

Enrolled nurses getting sacked, palliative care hospitalisations on the up and new guidelines under review.

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Eighteen months on from the Royal Commission report into aged care quality and safety, the sector is slowly reforming – but teething problems abound.

Residential care providers are already exploiting loopholes in well-intentioned policy, with the AMA warning that the incoming new clinical standard is too high level and vague.

Enrolled nurses out, cheaper workers in

The Australian Nursing and Midwifery Federation claims that aged care homes are making enrolled nurses redundant in an effort to cut costs, and substituting personal care workers.

Under new mandated minimum care minutes system, introduced in October, every aged care service must have a registered nurse on site at all times and each resident must receive 200 minutes of care per day.

Registered nurses must deliver a minimum 40 minutes of care, and the rest of the time is intended to be shared by enrolled nurses and personal care workers.

There’s no minimum training requirement to become a personal care worker, and they are paid less than an enrolled nurse.

Because there’s no specified minimum number of minutes which must be delivered by an enrolled nurse, aged care providers aren’t necessarily obliged to keep them on staff.

At Southern Cross Care Tasmania, the ANMF said, some providers are laying off enrolled nurses and hiring personal care workers in their place.

Health Minister Mark Butler called the move “unacceptable” and has asked the Department of Health to “provide a response which will prevent this from happening”.

In NSW, some enrolled nurses are reportedly being offered personal care worker contracts.

ANMF federal secretary Annie Butler said the actions of these providers were “unconscionable”, especially given the current covid-19 resurgence.

“Providers certainly know that the Royal Commission recommended more qualified nurses in aged care, not less,” she said.

“The Albanese Government’s reforms aim to improve care in nursing homes by ensuring an appropriate skills mix … but without mandated requirements specifying skill mix percentages, providers are gaming the system to dilute the skill mix.”

Catholic Health Australia, of which Southern Cross Care is a member, has defended the aged care provider and said it has continued to invest in upgrading services despite operating at a loss.

Organisation CEO Pat Garcia suggested that enrolled nurses should be able to contribute to the minimum care minutes instead of registered nurses.

“Enrolled nurses are more than capable of performing daily care including taking blood pressure tests and developing clinical care plans,” he said.

“We should allow them to continue performing those duties by recognising them in the 40 nurse care minutes.”

As a kicker, aged care providers are receiving increased federal funding over the next three years to support the recruitment of more staff.

AMA pushes for more detail in clinical care standard

Meanwhile, the AMA has criticised the current aged care quality clinical standard, which is under review, as being too vague.

“While the important principles of respect, dignity, and engagement with older people were noted, these standards altered the administrative duties of aged care providers but did not improve the actual care provision for the older person,” the organisation said.

The additional administrative duties, it said, are nothing more than “tick-box” exercises.

Under the current standard, there is no clear designation of roles. This means that clinical tasks like medication management can be delegated to personal care workers by providers.

There’s also no medical access standard to set out minimum protocols, equipment and facilities for doctors who make visits to residential care homes.

The AMA has been calling for this standard to be created for some time.

“From the GP perspective, the protocols would outline when the GP is prepared to be available to respond with a visit or by phone/telehealth, for what … and, if they are not available, who then is clinically responsible and should be called,” the AMA said.

The final recommendation from the association was to do with upskilling aged care staff in palliative care.

This would entail additional nurse training on setting up syringe drivers, as well as all-staff training on talking to patients and family members about end of life care, managing family conflict and the cultural, religious and spiritual aspects of palliative care.

The AMA said it understands that there are instances where aged care residents are transferred to hospital for palliative care due to undertrained staff.

Palliative care hospitalisations increase

Data from the Australian Institute of Health and Wellness, released last month, supports the AMA’s observation.

It found that palliative care-related hospitalisations increased by 18% in the five years to 2020.

Rates of hospitalisation for all causes rose by just 6% in the same period.

Length-of-stay for palliative care was also roughly twice as long as that of other conditions.

“This has a big impact on our already stretched hospital system and may not be what many people want at the end of their life,” Palliative Care Australia CEO Camilla Rowland said.